Oper Neurosurg (Hagerstown). 2017 Feb 1;13(1):69-76. doi: 10.1227/NEU.0000000000001258.
Surgical intervention has been proposed as a means of reducing the high morbidity and mortality associated with acute intracerebral hemorrhage (ICH), but many previously reported studies have failed to show a clinically significant benefit. Newer, minimally invasive approaches have shown some promise.
We report our early single-center technical experience with minimally invasive clot evacuation using the BrainPath system.
Prospective data were collected on patients who underwent ICH evacuation with BrainPath at the Cleveland Clinic from August 2013 to May 2015.
Eighteen patients underwent BrainPath evacuation of ICH at our center. Mean ICH volume was 52.7 mL ± 22.9 mL, which decreased to 2.2 mL ± 3.6 mL postevacuation, resulting in a mean volume reduction of 95.7% ± 5.8% (range 0-14 mL, P < .001). In 65% of patients, a bleeding source was identified and treated. There were no hemorrhagic recurrences during the hospital stay. In this cohort, only 1 patient (5.6%) died in the first 30 days of follow-up. Median Glasgow Coma Score improved from 10 (interquartile range 5.75-12) preoperation to 14 (interquartile range 9-14.25) postoperation. Clinical follow-up in this cohort is ongoing.
Evacuation of ICH using the BrainPath system is safe and technically effective. The volume of clot removed compares favorably with other published studies. Early improved clinical outcomes are suggested by improvement in Glasgow Coma Score and reduced 30-day mortality. Ongoing analysis is necessary to elucidate long-term clinical outcomes and the subsets of patients who are most likely to benefit from surgery.
外科干预被提议作为降低与急性脑出血（ICH）相关的高发病率和死亡率的一种手段，但许多先前的报告研究未能显示出临床显著获益。更新的、微创的方法显示出了一些希望。
我们报告了我们在克利夫兰诊所使用 BrainPath 系统进行微创血肿清除的早期单中心技术经验。
前瞻性地收集了 2013 年 8 月至 2015 年 5 月期间在克利夫兰诊所接受 BrainPath 行 ICH 清除术的患者的数据。
我们中心有 18 名患者接受了 BrainPath 清除 ICH。ICH 体积平均为 52.7 ± 22.9 mL，清除术后降至 2.2 ± 3.6 mL，体积减少平均为 95.7% ± 5.8%（范围 0-14 mL，P<.001）。在 65%的患者中，发现并治疗了出血源。在住院期间没有发生出血性再发。在该队列中，仅有 1 名患者（5.6%）在随访的前 30 天死亡。格拉斯哥昏迷评分中位数从术前的 10 分（四分位距 5.75-12）提高到术后的 14 分（四分位距 9-14.25）。该队列的临床随访仍在继续。
使用 BrainPath 系统清除 ICH 是安全且技术有效的。清除的血肿量与其他已发表的研究相比具有优势。格拉斯哥昏迷评分的改善和 30 天死亡率的降低表明早期临床结局得到改善。需要进一步的分析来阐明长期临床结局以及最有可能从手术中获益的患者亚组。
